The purpose of the Women Veterans Cohort Study (WVCS) is to identify the unique chronic healthcare risks and needs of women Veterans who served during the Iraq and Afghanistan conflicts (OIF/OEF/OND). During these conflicts the overall representation of women in military service has increased to 20%, and over 50% of women Veterans have enrolled for VHA care compared to 11% in prior eras. Thus, the need to understand the unique healthcare needs of women veterans is essential for future planning. During the 5-years of WVCS Wave 1 we created, a) an electronic database cohort of all VHA enrolled Veterans of OIF/OEF/OND conflicts (N>800,000), and b) a prospective Veteran cohort that has completed surveys annually for 3 years (N>700). We have found so far that compared to men, women Veterans of OEF/OIF/OND are more likely to have musculoskeletal and mental health conditions (depression or adjustment disorders) and are less likely to receive management for cardiovascular risk factors. They also have higher rates of outpatient utilization and costs for pharmacy and outpatient care. Further tracking of these cohorts and complementary data collection is essential if we are to understand the unique disease trajectory and treatment needs of women OIF/OEF/OND veterans, and if we are to inform the structure and delivery of healthcare to women Veterans so as to alter the trajectory of disease and disability, and substantially reduce future healthcare expenditures by VHA. The proposed 4-year WVCS 2 will leverage the two WVCS 1 components of the overall cohort to identify longitudinally, the 1) predictors of, 2) psychiatric and psychosocial moderators of, 3) treatment patterns for, and 4) barriers to care for painful musculoskeletal conditions, mental health conditions, and CVD risk uniquely experienced by women Veterans. Our aims are to 1) determine the pattern of disease onset and progression among women OEF/OIF/OND Veterans compared to men, 2) determine the unique psychiatric and psychosocial moderators of disease progression for women OIF/OEF/OND Veterans, 3) determine unique care patterns for women OIF/OEF/OND veterans, and 4) determine the barriers to care that arise for women Veterans. The main research methods will include, 1) collection and analysis of existing and newly available VA electronic health record and administrative data, 2) additional surveys to an expanded catchment area (new recruitment from LA and Durham), and 3) performance of focus groups from 4 Women's Health Practice Based Research Network sites (West Haven, LA, Durham and Northhampton VAs) to obtain important qualitative data. Significance. The WVCS Wave 2 will provide critical information that will help the VHA to achieve its goal of providing equitable, high quality, comprehensive healthcare services in a sensitive and safe environment at all VA facilities, so that VHA may continue its role as a national leader in the provision of health care for women Veterans, thereby raising the standard of care for women everywhere.